Sweat is your body's internal temperature regulator. For some people, however, the body produces much more perspiration than it needs to stay cool. This condition is known as hyperhidrosis. The exact cause is unknown but estimates suggest that up to 4% of the population suffer from hyperhidrosis and up to 21% of the population are bothered on a daily basis by the amount of sweat they produce. The most common sites for excessive sweating are the underarms followed by the scalp, palms and feet.
When should energy-based devices such as lasers or microwaves be used?
- When excessive sweating of the underarms, forehead, upper lip, palms and feet occurs without any reason, impacting quality of life
- You experience discomfort and/or embarrassment from this condition
- Prescription medicines or devices are ineffective
Prescription antiperspirants such a DrySol can be effective however, they may also be very irritating and many patient only achieve limited improvement. Electrophoresis is an effective treatment for palms and feet but is not performed for the underarm. Injections of botulinum toxins are very effective and can be used on any skin area. The effects of botulinum toxin on sweat glands normally last about 3-6 months. In the past the only permanent treatment for excessive sweating was the cutting of the nerve which triggered the sweat glands in questions. This procedure, called a sympathectomy, is effective in shutting down the target glands but as many 80% of patients with suffer compensatory sweating over the abdomen and back after the procedure.
Advances in the use of energy-based devices to treat hyperhidrosis are providing options that are more permanent for the underarm compared to the above medical options. There are several energy-based devices that when used under the guidance of a physician are very effective. These devices all use heat to destroy sweat glands. Their effects look to be long lasting and may be permanent because once the glands are destroyed they do not regenerate.
Description of treatment
Laser wavelengths that treat fat such as 1320 nm and 1440 nm have also been shown to treat overactive sweat glands. The treatment area is numbed and then exposed to laser energy in order to destroy many of the glands. One to two treatments are normally necessary to achieve the level of dryness that patient desires. Mild swelling and bruising is common for a few days after the procedure. More significant side effects such as infection are possible but rare.
Microwave devices such as miraDry™ work by destroying sweat glands with heat. Cooling for the skin is applied while microwaves heat the sweat glands that are located at the dermal/fat border. These devices normally require two treatments and post procedure swelling can be significant.1
Ultrasound uses energy waves to heat the sweat glands. The waves are sent in at different angles which focus to a point under the skin creating a hot spot where the sweat glands reside. This keeps the skin cool while only heating the area at the focal point. Studies are ongoing as to the exact number of treatments needed, two may be optimal.
Success rates/potential complications
Long term data for all three types of treatment is growing. Currently literature shows that all procedures have shown 90% patient satisfaction after 12 months.
What outcome should patients expect?
Current treatment for excessive sweating with either laser, microwave or ultrasound can provide excellent long term results. Patient should expect mild to significant swelling for 1-2 weeks after the procedure depending on the device chosen.
1 Hyperhidrosis With a Microwave Device Mark Lupin, MD et al; Dermatol Surg 2014; 40: 805-807
David M. Verebelyi, MD